HIV-Stigma, Healthcare Barriers, & HIV and Mental Health Outcomes in South Africa

艾滋病毒耻辱、医疗保健障碍、

• 批准号: 8458408
• 负责人: Leslie Denise Williams
• 金额: $ 2.9万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8458408
• 关键词: 10 year old; AIDS/HIV problem; Address; Adult; Affect; Africa South of the Sahara; African; Anxiety; Caregivers; Caring; Cessation of life; Characteristics; Child; Child Mental Health; Chronically Ill; Clinical; Communities; Community Health Education; Counseling; Data; Dependence; Discrimination; Disease; Emotional; Face; Family; Grant; HIV; HIV Seropositivity; Health Services; Health Status; Healthcare; High Prevalence; Household; Incidence; Individual; Intervention; Knowledge; Life; Literature; Measures; Mediating; Medical; Mental Depression; Mental Health; Morbidity - disease rate; National Institute of Child Health and Human Development; Nature; Outcome; Participant; Pattern; Perception; Personal Satisfaction; Persons; Policies; Post-Traumatic Stress Disorders; Poverty; Prevention; Preventive; Preventive Health Services; Preventive Intervention; Process; Public Health; Religion and Spirituality; Research; Rural Community; Sampling; Selection Bias; Services; Shame; South Africa; Stigmatization; Surveys; Testing; Treatment Efficacy; Work; base; cohesion; condoms; experience; humiliation; improved; mortality; peer; prevent; social; social stigma

DESCRIPTION (provided by applicant): Empirical evidence suggests that HIV/AIDS-related stigma in Sub-Saharan Africa is a significant problem that potentially limits the efficacy of HIV/AIDS prevention and treatment-based health services by deterring individuals from utilizing these services. As such, it is expected to be related to both health service barriers and HIV and outcomes, and to mental health outcomes among HIV-positive or -affected individuals. However, despite the ecologically and contextually dependent nature of stigma, and the high prevalence of HIV in Sub-Saharan Africa, these relationships have not been adequately tested at the community-level in this context. The long-term objective of the proposal is to expand the literature on HIV/AIDS-related stigma in Sub-Saharan Africa to include multi-level analysis of ecological mechanisms underlying the relationships among stigma, barriers to health services, and HIV and mental health outcomes, among a systematic sample. The current project uses cross-sectional quantitative data from the Well-being of South African Children: Household, Community, and Policy Influences project in KwaZulu-Natal, South Africa (NICHD Grant No. 1R01HD055137) to complete two related studies. These data are well-suited to address the limitations of previous literature because the sample is composed of randomly-selected clusters of households within 24 urban and rural communities in KwaZulu-Natal and includes both HIV-positive and -negative participants representing a broad range of socio-demographic characteristics. Also, the data nest individuals within households within communities, allowing for multi-level analysis of the inherently ecological social processes underlying HAR stigma and its relationship to health service barriers, HIV outcomes, and mental health. The full sample will include a targeted 1,800 households with 7-10-year-old children. All measures are survey-based. Measures of HIV outcomes include HIV incidence and HIV/AIDS-related death. Measures of mental health include depression, anxiety, and child PTSD. HGLM will be used to test all hypotheses for both studies. The first study focuses on HIV outcomes at the household- and community-levels and hypothesizes that there are significant multi- and cross-level relationships among stigma, health service barriers, and HIV outcomes, with health service barriers partially mediating the relationship between stigma and HIV outcomes. The second study uses individual- and community-level data to predict mental health outcomes among only the subset of the sample that is living in a household with one or more HIV-positive person. This study hypothesizes that there are significant relationships between HIV/AIDS-related stigma at both levels of analysis and both caregiver and child mental health. It also hypothesizes that barriers to health care mediate each of these relationships. The proposed project has important implications for public health. HIV/AIDS-related stigma is hypothesized to be predictive of processes through which HIV treatment and preventive health services work or fail to work, and as such is critical to understanding how to improve such services.

描述（由申请人提供）：经验证据表明，撒哈拉以南非洲艾滋病毒/艾滋病相关的污名是一个重大问题，它可能通过阻止使用这些服务来限制艾滋病毒/艾滋病预防和基于治疗的卫生服务的功效。因此，预计将与卫生服务障碍，艾滋病毒和结果以及HIV阳性或受影响的个体之间的心理健康成果有关。然而，尽管污名的生态和上下文依赖性以及撒哈拉以南非洲的艾滋病毒的高流行率，但在这种情况下，这些关系在社区层面上尚未得到充分的测试。该提案的长期目标是扩大撒哈拉以南非洲艾滋病毒/艾滋病相关的污名的文献，包括对污名，卫生服务障碍以及艾滋病毒和心理健康成果之间关系的生态机制的多层次分析。当前的项目使用南非儿童福祉的横断面定量数据：家庭，社区和政策影响南非夸祖鲁 - 纳塔尔省（NICHD GRANT No. 1R01HD055137）完成两项相关研究。这些数据非常适合解决以前的文献的局限性，因为样本由夸祖鲁 - 纳塔尔邦24个城市和农村社区内的随机选择的家庭集群组成，其中包括代表广泛社会学特征的HIV阳性和负参与者。此外，数据嵌套在社区内的家庭中，可以对HAR污名基础的固有生态社会过程及其与卫生服务障碍，HIV成果和心理健康的关系进行多层次分析。完整的样本将包括有7-10岁儿童的目标1,800户家庭。所有措施都是基于调查的。 HIV结局的措施包括HIV发病率和与HIV/AIDS相关的死亡。心理健康的度量包括抑郁症，焦虑和儿童PTSD。 HGLM将用于测试两项研究的所有假设。第一项研究的重点是家庭和社区级别的艾滋病毒结局，并假设在污名，卫生服务障碍和艾滋病毒障碍之间存在重大的多个和跨层次的关系，而卫生服务障碍部分介导了污名和艾滋病毒的关系之间的关系。第二项研究使用个人和社区级别的数据来预测仅生活在一个或多个HIV阳性人家庭中的样本中的一个子集中。这项研究假设在分析水平与照料者和儿童心理健康之间，与艾滋病毒/艾滋病相关的污名之间存在显着关系。它还假设医疗保健的障碍会调解这些关系中的每一个。拟议的项目对公共卫生具有重要意义。假设与艾滋病毒/艾滋病相关的污名可以预测艾滋病毒治疗和预防性卫生服务有效或无效的过程，因此对于理解如何改善此类服务至关重要。